Hybrid cardiac rehabilitation in patients with durable left ventricular assist devices: the REHAB-ASSIST study

Purpose Patients with durable left ventricular assist devices (LVADs) frequently remain functionally limited despite technological advances. Cardiac rehabilitation may improve functional status, yet access is limited, and hybrid models have not been evaluated. The REHAB-ASSIST study assessed the clinical outcomes, safety, and feasibility of a hybrid cardiac rehabilitation program in this population. Methods In this prospective multicenter proof-of-concept study, LVAD recipients underwent a 12-week hybrid cardiac rehabilitation program combining supervised and telemedicine-supported home-based sessions. The primary clinical endpoint was change in peak oxygen uptake. Secondary endpoints included 6-minute walk distance and quality of life (Kansas City Cardiomyopathy Questionnaire). Safety and feasibility were assessed as separate prespecified domains. Exploratory analyses were performed at 6 months. Results Fifteen patients were enrolled and thirteen completed the program. Median age was 66 years and 93% were male; all had a HeartMate 3® LVAD. Peak oxygen uptake increased modestly but did not reach statistical significance (11.2 vs 12.2 mL/kg/min, p  = 0.11). Statistically significant and clinically meaningful improvements were observed in 6-minute walk distance (444 vs. 492 m, p  = 0.028) and Kansas City Cardiomyopathy Questionnaire (75.1 vs. 82.2 points, p  = 0.042). Ventilatory oscillations were significantly reduced (38.5% vs. 7.7%, p  = 0.045). No severe device-related or exercise-related adverse events occurred during the program. Conclusions In patients with LVADs, a hybrid CR program was feasible, with high center-based adherence and no severe exercise-related adverse events observed, and it was associated with meaningful improvements in 6-minute walk distance and quality of life. These findings suggest that submaximal and patient-centered endpoints may be more appropriate than peak oxygen uptake to evaluate rehabilitation in this population, and require confirmation in randomized trials.